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Central venous catheter-related complications in newborns and infants: a 587-case survey
M F Goutail-Flaud1, M Sfez, A Berg
1Department of Anesthesia and Intensive Care, University Hospital St Vincent de Paul, Paris, France.
Insights
Low birth weight and proximal insertion sites increase central venous catheter complications in infants. Polyurethane catheters were associated with fatal complications, suggesting silicone is preferable for newborns and small infants.
Area of Science:
- Pediatrics
- Medical Devices
- Infectious Diseases
Background:
- Central venous catheters (CVCs) are crucial for neonatal and infant care.
- CVC-related complications pose significant risks, including mechanical issues and infections.
Purpose of the Study:
- To identify factors influencing central venous catheter-related complications in newborns and infants.
- To compare complication rates based on infant weight, catheter insertion site, placement technique, and material.
Main Methods:
- Retrospective analysis of 587 cases involving central venous catheters.
- Evaluation of infant body weight, catheter insertion site (proximal vs. distal), placement technique (surgical vs. percutaneous), and material (silicone vs. polyurethane).
Main Results:
- Overall complication rate was 28%, with mechanical complications (22%) and septic complications (4%).
- Lower infant body weight (<2,500 g) and proximal insertion sites were associated with significantly higher complication rates.
- Fatal complications occurred exclusively with polyurethane catheters.
Conclusions:
- Infant body weight and catheter insertion site are critical factors in CVC complication risk.
- Polyurethane catheters should be avoided in newborns and small infants due to the risk of fatal complications.
Abstract:
In an attempt to identify factors determining central venous catheter-related complications in newborns and infants, 587 cases have been retrospectively analyzed. Attention has been paid to the influence of the incidence of babies' body weight, site of insertion, and technique of placement of the catheter and the material used, ie, silicone (SI) or polyurethane (PU). Overall complications occurred in 28% of the catheters with 2 deaths due to cardiac tamponade. Mechanical complications happened in 22% of the catheters, including dislodgement (11.6%), extracorporeal perforation (5.3%), and obstruction (5%). Septic complications occurred in 4% catheters, including proven bacteriemia (2.5%), abscess at the entry site (1%), and isolated fever (0.8%). Clinically evident caval thrombosis occurred in 1% of the catheters. Overall complications were significantly higher when the body weight was lower than 2,500 g (P less than .01) due to a significantly higher incidence of septic complications (P less than .05). When a proximal site of placement of the catheter was used, both septic and mechanical complications were more frequent than in the distal approach (P less than .01). The incidence of complications was similar in surgically and in percutaneously placed catheters as in SI and PU catheters. Nevertheless, fatal complications occurred only in PU catheters, leading us to avoid the choice of such material in newborns and small infants.